Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Int J Cardiol. 2020 May 1;306:1-7. doi: 10.1016/j.ijcard.2020.02.051. Epub 2020 Feb 20.
The long-term outcomes and optimal treatment strategy for patients with Takayasu arteritis (TA) and significant coronary stenosis remain unclear. We aim to investigate the prognosis of these patients according to the initial management strategy.
A total of 57 consecutive patients with TA and significant coronary stenosis were included between 2002 and 2018. The cohort was divided into the percutaneous coronary intervention (PCI) group (n = 18), coronary artery bypass graft (CABG) group (n = 10), and medical-therapy group (n = 29). The primary outcome was major adverse cardiac events (MACEs) defined as a composite of cardiac death, myocardial infarction, and coronary revascularization.
Over a median follow-up of 4.5 (IQR 3.5-8.0) years, 24 (42.1%) patients experienced at least one MACE. The long-term rates of MACEs and re-revascularization were significantly higher in the PCI group than in the other 2 groups (HR 5.306, 95% CI 2.160-13.036, p < 0.001; HR 12.286, 95% CI 3.257-46.343, p < 0.001, respectively). The cumulative incidences of MACEs and subsequent revascularization were similar between the CABG and medical-therapy group. Active disease at baseline and PCI were independent predictors of MACEs (HR, 7.039, 95% CI 2.031-24.396; p = 0.002; HR, 4.400; 95% CI 1.804-10.727; p = 0.001, respectively) and revascularization (HR 4.632, 95% CI 1.010-21.235, p = 0.048; HR 9.820, 95% CI 2.641-36.514, p = 0.001, respectively).
The initial baseline active disease is an important predictor of long-term outcome and subsequent revascularization in patients with TA and significant coronary artery stenosis. Also, PCI is independently associated with higher risk of MACEs and re-revascularization.
Takayasu 动脉炎（TA）伴严重冠状动脉狭窄患者的长期预后和最佳治疗策略仍不清楚。我们旨在根据初始治疗策略研究这些患者的预后。
2002 年至 2018 年间共纳入 57 例 TA 伴严重冠状动脉狭窄的连续患者。该队列分为经皮冠状动脉介入治疗（PCI）组（n=18）、冠状动脉旁路移植术（CABG）组（n=10）和药物治疗组（n=29）。主要终点是主要不良心脏事件（MACE），定义为心脏死亡、心肌梗死和冠状动脉血运重建的复合事件。
中位随访时间为 4.5（IQR 3.5-8.0）年，24 例（42.1%）患者至少发生 1 次 MACE。与其他 2 组相比，PCI 组的长期 MACE 和再血运重建率明显更高（HR 5.306，95%CI 2.160-13.036，p<0.001；HR 12.286，95%CI 3.257-46.343，p<0.001）。CABG 组和药物治疗组之间的 MACE 和随后的血运重建的累积发生率相似。基线时活动性疾病和 PCI 是 MACE（HR 7.039，95%CI 2.031-24.396；p=0.002；HR 4.400；95%CI 1.804-10.727；p=0.001）和血运重建（HR 4.632，95%CI 1.010-21.235，p=0.048；HR 9.820，95%CI 2.641-36.514，p=0.001）的独立预测因子。
TA 伴严重冠状动脉狭窄患者的初始基线活动性疾病是长期预后和随后血运重建的重要预测因素。此外，PCI 与更高的 MACE 和再血运重建风险独立相关。
